EXSS is Exercising Science Solutions for Public Impact

Exploring The Impact of EXSS: Exercise Oncology

One of the most exciting things about the Department of Exercise and Sport Science is our diverse research agenda. Our research programs range across a wide spectrum of impactful areas, such as marketing and branding, shoulder injury prevention, risk management, healthy aging, and osteoarthritis, just to name a few. To highlight our research efforts, we will summarize the latest research being conducted by EXSS faculty and students, and discuss how this work directly impacts the public.

This week, we highlight some of the recent research in the area of exercise oncology. Professor Claudio Battaglini recently published a new paper, which investigates the influence of cardiorespiratory fitness on patient response’s to bone marrow transplantation. The study was recently published in Bone Marrow Transplantation and is entitled (click on link to access the paper) “Cardiorespiratory fitness in patients undergoing hematopoietic SCT: a pilot study”.

Professor Battaglini provides a brief summary that describes why this study is important and how it impacts the public.

1) Why we did this study?
We conducted this study because maximal exercise testing that measures cardiorespiratory function (VO2peak) has been shown to have prognostic value for mortality in certain cancer populations (i.e.; Lung Cancer Patients). For patients with life-threatening blood cancers, bone marrow transplantation increases the chances for longer survival when compared to standard anti-cancer treatment. However, these benefits may be offset by the development of post-transplant treatment-related side effects, which may lead to patient death. For patients who receive Myeloablative allogeneic transplantation, for example, there is a risk of 30-40% of treatment related mortality. Therefore, there is a need to develop prognostic measures to assess whether or not patients are prepared for transplantation. This information can inform the clinician and patient decision-making process by helping to determine those who are “fit” for transplant and have limited treatment-related risks. The purpose of the study was to evaluate the feasibility of assessing VO2peak and 6 minutes walking test (6MWT) prior to transplant and to evaluate the relationship between VO2peak and 6MWT measured at baseline with patient-reported outcomes, measurements of functional capacity, symptomatic treatment toxicities, and quality of life (QOL) evaluated prior to transplant and weekly for 100 days post-transplant to verify if VO2peak and 6MWT could potentially be used as a useful clinical prognostic indicator for patients undergoing bone marrow transplantation. To our knowledge, this was the first study conducted in bone marrow transplant patients prior to transplant where cardiorespiratory function was measured directly using a VO2peak test with gas exchange with follow up test conducted 100 days post-transplant with weekly measurements of symptomatic treatment toxicities and quality of life.

2) What we did in the study?
We assessed cardiorepiratory function (VO2peak using a cycle ergometer and a mobile/portable metabolic system) and 6-minutes walk test in the bone marrow transplant unit hallway at the NC Cancer Hospital prior to transplant and again 100 days post-transplant. We also assessed symptomatic treatment toxicities and quality of life prior to transplant, weekly throughout the entire study, and 100 days post-transplant to evaluate their relationship with VO2peak and 6MWT.

3) What we found and how it impacts the public?
We found that it was feasible to conduct cardiorepiratory function (VO2peak) testing with gas exchange in-hospital prior to transplant safely. In addition, we observed that VO2peak testing predicts mortality risk, physical and mental health status, symptomatic treatment toxicity and hospital days. Furthermore, VO2peak was strongly positively correlated with the 6MWT, suggesting that these tests may measure similar characteristics of patient functional capacity and could somewhat be used interchangeably, particularly for patients who cannot complete maximal exercise testing because of symptom limitations.
In other words, patients with reduced pre-transplant VO2peak experience higher symptom burden, worse QOL, and a greater likelihood of death following bone marrow transplantation. These findings suggest that patients with reduced pre-transplant cardiorespiratory function could potentially experience less post-transplant complications and increase their chances for extended survival by increasing their cardiorespiratory function prior to transplant. A study investigating this possibility is currently being conducted at the UNC Hospitals Bone Marrow Transplant Unit in collaboration with the Department of Exercise and Sport Science.

This study is a great example of the multiple ways our faculty are making and #EXSSimpact to positively impact society.